Hospital length of stay throughout bed pathways and factors affecting this time: A non-concurrent cohort study of Colombia COVID-19 patients and an unCoVer network project.

Predictions of hospital beds occupancy depends on hospital admission rates and the length of stay (LoS) according to bed type (general ward -GW- and intensive care unit -ICU- beds). The objective of this study was to describe the LoS of COVID-19 hospital patients in Colombia during 2020-2021. Accelerated failure time models were used to estimate the LoS distribution according to each bed type and throughout each bed pathway. Acceleration factors and 95% confidence intervals were calculated to measure the effect on LoS of the outcome, sex, age, admission period during the epidemic (i.e., epidemic waves, peaks or valleys, and before/after vaccination period), and patients geographic origin. Most of the admitted COVID-19 patients occupied just a GW bed. Recovered patients spent more time in the GW and ICU beds than deceased patients. Men had longer LoS than women. In general, the LoS increased with age. Finally, the LoS varied along epidemic waves. It was lower in epidemic valleys than peaks, and decreased after vaccinations began in Colombia. Our study highlights the necessity of analyzing local data on hospital admission rates and LoS to design strategies to prioritize hospital beds resources during the current and future pandemics.

Socioeconomic disparities associated with mortality in patients hospitalized for COVID-19 in Colombia.

Socioeconomic disparities play an important role in the development of severe clinical outcomes including deaths from COVID-19. However, the current scientific evidence in regard the association between measures of poverty and COVID-19 mortality in hospitalized patients is scant. The objective of this study was to investigate whether there is an association between the Colombian Multidimensional Poverty Index (CMPI) and mortality from COVID-19 in hospitalized patients in Colombia from May 1, 2020 to August 15, 2021. This was an ecological study using individual data on hospitalized patients from the National Institute of Health of Colombia (INS), and municipal level data from the High-Cost Account and the National Administrative Department of Statistics. The main outcome variable was mortality due to COVID-19. The main exposure variable was the CMPI that ranges from 0 to 100% and was categorized into five levels: (i) level I (0%-20%), (ii) level II (20%-40%), (iii) level III (40%-60%), (iv) level IV (60%-80%); and (v) level V (80%-100%). The higher the level, the higher the level of multidimensional poverty. A Bayesian multilevel logistic regression model was applied to estimate Odds Ratio (OR) and their corresponding 95% credible intervals (CI). In addition, a subgroup analysis was performed according to the epidemiological COVID-19 waves using the same model. The odds for dying from COVID-19 was 1.46 (95% CI 1.4-1.53) for level II, 1.41 (95% CI 1.33-1.49) for level III and 1.70 (95% CI 1.54-1.89) for level IV hospitalized COVID-19 patients compared with the least poor patients (CMPI level I). In addition, age and male sex also increased mortality in COVID-19 hospitalized patients. Patients between 26 and 50 years-of-age had 4.17-fold increased odds (95% CI 4.07-4.3) of death compared with younger than 26-years-old patients. The corresponding for 51-75 years-old patients and those above the age of 75 years were 9.17 (95% CI 8.93-9.41) and 17.1 (95% CI 16.63-17.56), respectively. Finally, the odds of death from COVID-19 in hospitalized patients gradually decreased as the pandemic evolved. In conclusion, socioeconomic disparities were a major risk factor for mortality in patients hospitalized for COVID-19 in Colombia.

Cost-utility analysis of dupilumab compared with endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps. Evaluation in Colombia, a developing country.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) compromises respiratory function, sleep, concentration, work capacity, and quality of life, generating high costs for patients and health systems. The aim of the study was to analyze the cost utility of Dupilumab compared to endoscopic sinus surgery for patients with CRSwNP. RESEARCH DESIGN AND METHODS: We developed a model-based cost-utility analysis from the perspective of the Colombian health system to compare Dupilumab vs. endoscopic nasal surgery in patients with difficult-to-treat CRSwNP. Transition probabilities were extracted from the published literature about CRSwNP, and costing was based on local tariffs. We performed probabilistic sensitivity analysis for outcomes, probabilities, and costs (10.000 Monte Carlo simulations). RESULTS: The cost of dupilumab ($ 142.919) was 7.8 times higher than nasal endoscopic sinus surgery ($ 18.347). In terms of quality-adjusted life years (QALYs), surgery generates better results than Dupilumab: 11.78 vs. 9.05 QALYs. CONCLUSIONS: From the perspective of the health system, endoscopic sinus surgery for the management of CRSwNP is a dominant alternative in all the analyzed scenarios compared to the use of Dupilumab. From a cost-utility point of view, the use of dupilumab should be considered when the patient requires multiple surgeries or when there is a contraindication for surgery performance.

Comparison of Anti-SARS-CoV-2 IgG Antibody Responses Generated by the Administration of Ad26.COV2.S, AZD1222, BNT162b2, or CoronaVac: Longitudinal Prospective Cohort Study in the Colombian Population, 2021/2022.

To mitigate the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccines have been rapidly developed and introduced in many countries. In Colombia, the population was vaccinated with four vaccines. Therefore, this research aimed to determine the ability of the vaccines introduced in the National Vaccination Plan to prevent SARS-CoV-2 infection and induce seroconversion and sought to investigate the longevity of antibodies in the blood. We conducted a prospective, nonprobabilistic, consecutive cross-sectional cohort study in a population with access to vaccination with CoronaVac, Ad26.COV2.S, AZD1222, and BNT162b2 from March 2021 to March 2022. The study included 1327 vaccinated people. A plurality of participants were vaccinated with BNT162b2 (36.1%; n = 480), followed by Ad26.COV2.S (26.9%; n = 358), CoronaVac (24%; n = 331), and AZD1222 (11.9%; n = 158). The crude seroprevalence on day zero varied between 18.1% and 57.8%. Participants who received BNT162b2 had a lower risk of SARS-CoV-2 infection than those who received the other vaccines. Participants who were immunized with BNT162b2 and AZD1222 had a higher probability of losing reactivity on day 210 after receiving the vaccine.

Type 1 and type 2 diabetes mellitus: Clinical outcomes due to COVID-19. Protocol of a systematic literature review.

INTRODUCTION: Diabetes has been associated with an increased risk of complications in patients with COVID-19. Most studies do not differentiate between patients with type 1 and type 2 diabetes, which correspond to two pathophysiological distinct diseases that could represent different degrees of clinical compromise. OBJECTIVE: To identify if there are differences in the clinical outcomes of patients with COVID-19 and diabetes (type 1 and type 2) compared to patients with COVID-19 without diabetes. METHODS: Observational studies of patients with COVID-19 and diabetes (both type 1 and type 2) will be included without restriction of geographic region, gender or age, whose outcome is hospitalization, admission to intensive care unit or mortality compared to patients without diabetes. Two authors will independently perform selection, data extraction, and quality assessment, and a third reviewer will resolve discrepancies. The data will be synthesized regarding the sociodemographic and clinical characteristics of patients with diabetes and without diabetes accompanied by the measure of association for the outcomes. The data will be synthesized regarding the sociodemographic and clinical characteristics of patients with diabetes and without diabetes accompanied by the measure of association for the outcomes. EXPECTED RESULTS: Update the evidence regarding the risk of complications in diabetic patients with COVID-19 and in turn synthesize the information available regarding type 1 and type 2 diabetes mellitus, to provide keys to a better understanding of the pathophysiology of diabetics. SYSTEMATIC REVIEW REGISTRY: This study was registered at the International Prospective Registry for Systematic Reviews (PROSPERO)-CRD42021231942.

Comparison of 1-year healthcare resource utilization and related costs for patients with heart failure in the Chagas and non-Chagas matched cohorts.

Background: Chagas disease is one of the leading causes of heart failure (HF) in Latin Americans, and there are limited data available that examine related costs of care for patients with HF. This study aimed to compare healthcare resource utilization and related costs for patients with HF, with and without Chagas disease. Methods: A prospective matched-cohort study comparing the healthcare costs for patients with HF with Chagas disease and care costs for patients with HF without Chagas disease was conducted between January 2019 and December 2019. Only direct costs have been estimated, including hospitalization costs, medications and other cardiovascular interventions, and clinical and laboratory follow-up for up to 1 year. Results: A total of 80 patients with chronic HF were included in the study. Of the 80 patients, 40 patients in the Chagas cohort and 40 patients in the non-Chagas cohort were matched for age, insurer and sex. From a social security system perspective, the total costs for the two cohorts during the study period were U$970,136. Specifically, the healthcare costs for the Chagas cohort were greater than the total healthcare costs for the non-Chagas group (U$511,931 versus U$458,205; p = 0.6183) Most costs were associated with hospitalizations (65.5% versus 59.6%), with averages of U$12,798.5 and U$11,455.1 per person in the Chagas and non-Chagas groups, respectively. In both the Chagas (51.6%) and non-Chagas cohorts (54.5%), causes of readmission unrelated to HF outweighed causes of readmission related to HF. High incidences of hospital admissions were observed during the rainy (cold) season for both cohorts. Conclusions: Over a 12-month follow-up period, patients with chronic HF and Chagas consume as many healthcare resources as those with chronic HF and without Chagas. These data highlight the considerable and growing economic burden of HF on the Colombian health system.

In Vitro Inhibition of Replication of Dengue Virus Serotypes 1-4 by siRNAs Bound to Non-Toxic Liposomes.

Dengue virus is a ssRNA+ flavivirus, which produces the dengue disease in humans. Currently, no specific treatment exists. siRNAs regulate gene expression and have been used systematically to silence viral genomes; however, they require controlled release. Liposomes show favorable results encapsulating siRNA for gene silencing. The objective herein was to design and evaluate in vitro siRNAs bound to liposomes that inhibit DENV replication. siRNAs were designed against DENV1-4 from conserved regions using siDirect2.0 and Web-BLOCK-iT™ RNAiDesigner; the initial in vitro evaluation was carried out through transfection into HepG2 cells. siRNA with silencing capacity was encapsulated in liposomes composed of D-Lin-MC3-DMA, DSPC, Chol. Cytotoxicity, hemolysis, pro-inflammatory cytokine release and antiviral activity were evaluated using plaque assay and RT-qPCR. A working concentration of siRNA was established at 40 nM. siRNA1, siRNA2, siRNA3.1, and siRNA4 were encapsulated in liposomes, and their siRNA delivery through liposomes led to a statistically significant decrease in viral titers, yielded no cytotoxicity or hemolysis and did not stimulate release of pro-inflammatory cytokines. Finally, liposomes were designed with siRNA against DENV, which proved to be safe in vitro.

Diagnóstico y tratamiento de la rinosinusitis crónica en adultos. Consenso de expertos: Asociación Colombiana de Otorrinolaringología-2021. / Diagnosis and treatment of chronic rhinosinusitis in adults. Expert consensus: Asociación Colombiana de Otorrinolaringología -2021.

Introducción: la Rinosinusitis Crónica se define como la inflamación crónica de la nariz y los senos paranasales por más de 12 semanas. La prevalencia varía entre el 5% - 30% de acuerdo con la zona geográfica según un estudio de carga de enfermedad (2012-2014), la prevalencia de las enfermedades respiratorias crónicas (rinitis y sinusitis crónica) varió entre el 10% y el 25%. Objetivo: establecer un conjunto de consideraciones basadas en consenso de expertos, para el diagnóstico y el tratamiento de la rinosinusitis crónica en pacientes adultos, en el contexto colombiano. Métodos: se llevó a cabo un consenso formal (Delphi y nominal). Se conformó un grupo de expertos, se definieron el alcance y las preguntas. Se realizaron dos rondas de calificación anónimas, y una discusión para las preguntas sin consenso. En las preguntas con opciones de uno a nueve, se consideró consenso con una mediana de uno a tres o de siete a nueve. En las preguntas tipo Likert, se consideró consenso un porcentaje igual o superior al 80% en acuerdos o desacuerdos. Resultados: se definieron y calificaron 18 preguntas, con la participación de 17 otorrinolaringólogos, de 8 ciudades colombianas, todos miembros de la Asociación Colombiana de Otorrinolaringología y con un promedio de experticia de 19.2 años (Desviación estándar [DE]: 10,2). Se obtuvieron 18 recomendaciones para el diagnóstico y el tratamiento de esta patología. Conclusiones: las recomendaciones emitidas por los expertos permiten orientar y estandarizar el diagnóstico y el tratamiento de la rinosinusitis crónica en adultos, en el contexto de los servicios de salud en Colombia.

Introduction: Chronic Rhinosinusitis is defined as chronic inflammation of the nose and paranasal sinuses for more than 12 weeks. The prevalence varies between 5% - 30% depending on the geographical area according to a disease burden study (2012-2014), the prevalence of chronic respiratory diseases (rhinitis and chronic sinusitis) varied between 10% - 25%. Objective: To establish a set of considerations based on expert consensus, for the diagnosis and treatment of chronic rhinosinusitis in adult patients, in the Colombian context. Methods: A formal consensus (Delphi and nominal) was carried out. A group of experts was formed, the scope and questions were defined. Two anonymous grading rounds were conducted, and a discussion for questions without consensus. In the Questions with options from one to nine were considered consensus with a median of one to three or seven to nine. In the Likert-type questions, a percentage equal to or greater than 80% in agreements or disagreements was considered consensus. Results: 18 questions were defined and scored, with the participation of 17 otorhinolaryngologists, from eight Colombian cities, all members of the Colombian Association of Otorhinolaryngology and with an average experience of 19.2 years (Standard desviation [SD]: 10.2). 18 recommendations were obtained for the diagnosis and treatment of this pathology. Conclusions: The recommendations issued by the experts allow to guide and standardize the diagnosis and treatment of chronic rhinosinusitis in adults, in the context of health services in Colombia.

SARS-CoV-2 and RT-PCR in asymptomatic patients: Results of a cohort of workers at El Dorado International Airport in Bogotá, 2020 / [SARS-CoV-2 y RT-PCR en pacientes asintomáticos: resultados de una cohorte de trabajadores del Aeropuerto Internacional El Dorado de Bogotá, 2020].

Introduction: The 2019 coronavirus pandemic (COVID-19) has caused around 25 million cases worldwide. Asymptomatic patients have been described as potential sources of transmission. However, there are difficulties to detect them and to establish their role in the dynamics of virus transmission, which hinders the implementation of prevention strategies. Objective: To describe the behavior of asymptomatic SARS-CoV-2 virus infection in a cohort of workers at the El Dorado "Luis Carlos Galán Sarmiento" International Airport in Bogotá, Colombia. Materials and methods: A prospective cohort of 212 workers from the El Dorado airport was designed. The follow-up began in June, 2020. A survey was used to characterize health and work conditions. Every 21 day, a nasopharyngeal swab was taken to identify the presence of SARS-CoV-2 using RT-PCR. We analyzed the behavior of the cycle threshold (ORF1ab and N genes) according to the day of follow-up. Results: In the first three follow-ups of the cohort, we found an incidence of SARS-CoV-2 infection of 16.51%. The proportion of positive contacts was 14.08%. The median threshold for cycle threshold was 33.53. Conclusion: We characterized the asymptomatic SARS-CoV-2 infection in a cohort of workers. The identification of asymptomatic infected persons continues to be a challenge for epidemiological surveillance systems.

Introducción. La pandemia de COVID-19 ha ocasionado cerca de 25 millones de casos en el mundo. Se ha descrito que los pacientes asintomáticos pueden ser fuentes de transmisión. Sin embargo, es difícil detectarlos y no es claro su papel en la dinámica de transmisión del virus, lo que obstaculiza la implementación de estrategias para la prevención. Objetivo. Describir el comportamiento de la infección asintomática por SARS-CoV-2 en una cohorte de trabajadores del Aeropuerto Internacional El Dorado "Luis Carlos Galán Sarmiento" de Bogotá, Colombia. Materiales y métodos. Se diseñó una cohorte prospectiva de trabajadores del Aeropuerto El Dorado. El seguimiento se inició en junio de 2020 con una encuesta a cada trabajador para caracterizar sus condiciones de salud y trabajo. Cada 21 días se tomó una muestra de hisopado nasofaríngeo para detectar la presencia del SARS-CoV-2 mediante reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se analizó el comportamiento del umbral del ciclo (cycle threshold) de los genes ORF1ab y N según el día de seguimiento. Resultados. En los primeros tres seguimientos de la cohorte se encontró una incidencia de la infección por SARS-CoV-2 del 16,51 %. La proporción de contactos positivos fue del 14,08 %. La mediana del umbral del ciclo fue de 33,53. Conclusión. Se determinaron las características de la infección asintomática por el SARSCoV-2 en una cohorte de trabajadores. La detección de infectados asintomáticos sigue siendo un reto para los sistemas de vigilancia epidemiológica.

SARS-CoV-2 y RT-PCR en pacientes asintomáticos: resultados de una cohorte de trabajadores del Aeropuerto Internacional El Dorado de Bogotá, 2020 / SARS-CoV-2 and RT-PCR in asymptomatic patients: Results of a cohort of workers at El Dorado International Airport in Bogotá, 2020

Introducción. La pandemia de COVID-19 ha ocasionado cerca de 25 millones de casos en el mundo. Se ha descrito que los pacientes asintomáticos pueden ser fuentes de transmisión. Sin embargo, es difícil detectarlos y no es claro su papel en la dinámica de transmisión del virus, lo que obstaculiza la implementación de estrategias para la prevención. Objetivo. Describir el comportamiento de la infección asintomática por SARS-CoV-2 en una cohorte de trabajadores del Aeropuerto Internacional El Dorado "Luis Carlos Galán Sarmiento" de Bogotá, Colombia. Materiales y métodos. Se diseñó una cohorte prospectiva de trabajadores del Aeropuerto El Dorado. El seguimiento se inició en junio de 2020 con una encuesta a cada trabajador para caracterizar sus condiciones de salud y trabajo. Cada 21 días se tomó una muestra de hisopado nasofaríngeo para detectar la presencia del SARS-CoV-2 mediante reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR). Se analizó el comportamiento del umbral del ciclo (cycle threshold) de los genes ORFlab y N según el día de seguimiento. Resultados. En los primeros tres seguimientos de la cohorte se encontró una incidencia de la infección por SARS-CoV-2 del 16,51 %. La proporción de contactos positivos fue del 14,08 %. La mediana del umbral del ciclo fue de 33,53. Conclusión. Se determinaron las características de la infección asintomática por el SARS-CoV-2 en una cohorte de trabajadores. La detección de infectados asintomáticos sigue siendo un reto para los sistemas de vigilancia epidemiológica.

Introduction: The 2019 coronavirus pandemic (COVID-19) has caused around 25 million cases worldwide. Asymptomatic patients have been described as potential sources of transmission. However, there are difficulties to detect them and to establish their role in the dynamics of virus transmission, which hinders the implementation of prevention strategies. Objective: To describe the behavior of asymptomatic SARS-CoV-2 virus infection in a cohort of workers at the El Dorado "Luis Carlos Galán Sarmiento" International Airport in Bogotá, Colombia. Materials and methods: A prospective cohort of 212 workers from the El Dorado airport was designed. The follow-up began in June, 2020. A survey was used to characterize health and work conditions. Every 21 day, a nasopharyngeal swab was taken to identify the presence of SARS-CoV-2 using RT-PCR. We analyzed the behavior of the cycle threshold (ORFlab and N genes) according to the day of follow-up. Results: In the first three follow-ups of the cohort, we found an incidence of SARS-CoV-2 infection of 16.51%. The proportion of positive contacts was 14.08%. The median threshold for cycle threshold was 33.53. Conclusion: We characterized the asymptomatic SARS-CoV-2 infection in a cohort of workers. The identification of asymptomatic infected persons continues to be a challenge for epidemiological surveillance systems.

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS.

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study.

INTRODUCTION: Closed loop total intravenous anesthesia is a technique in which the patient's hemodynamic and anesthetic depth variables are monitored, and based on this information, a computer controls the infusion rate of drugs to keep them within pre-established clinical parameters. OBJECTIVE: To describe the technical and clinical performance of a closed loop system for total intravenous anesthesia with propofol and remifentanil, using the SEDLineTM monitor. DESIGN: Multicentric prospective cohort study. SETTING: Surgery room. PATIENTS: ASA I-II undergoing elective surgery. MEASUREMENTS: The authors designed a closed loop system that implements a control algorithm based on anesthetic depth monitoring and the Patient State Index (PSITM) of the SEDLine monitor for propofol, and on hemodynamic variables for remifentanil. The measurement of clinical performance was made based on the percentage of PSITM maintenance time in the range 20-50. Precision analysis was evaluated by measuring median performance error (MDPE) can be defined as the median difference between actual and desired values, which refers to the degree of precision in which the controller is able to maintain the control variable within the objective set by the anesthesiologist; it represents the direction (over-prediction or under-prediction) of performance error (PE) rather than size of errors, which is represented by MDAPE, median absolute percentage error, Wobble index, which is used for measuring the intrasubject variability in performance error. RESULTS: Data were obtained from 93 patients in three healthcare centers. The percentage of PSITM maintenance time in the 20-50 range was 92% (80.7-97.0). MDPE was 10.7 (- 11.0-18.0), MDAPE 21.0 (14.2-26.8) and wobble 10.7 (7.0-16.9). No adverse surgical or anesthetic events were found. CONCLUSIONS: The closed loop total intravenous anesthesia system with SEDLine developed by the authors was used without major complication and appear to be feasible its use in clinical performance.

Evaluation of the Major Steps in the Conventional Protocol for the Alkaline Comet Assay.

Single cell gel electrophoresis, also known as the comet assay, has become a widespread DNA damage assessment tool due to its sensitivity, adaptability, low cost, ease of use, and reliability. Despite these benefits, this assay has shortcomings, such as long assay running time, the manipulation of multiple slides, individually, through numerous process steps, the challenge of working in a darkened environment, and reportedly considerable inter- and intra-laboratory variation. All researchers typically perform the comet assay based upon a common core approach; however, it appears that some steps in this core have little proven basis, and may exist, partly, out of convenience, or dogma. The aim of this study was to critically re-evaluate key steps in the comet assay, using our laboratory's protocol as a model, firstly to understand the scientific basis for why certain steps in the protocol are performed in a particular manner, and secondly to simplify the assay, and decrease the cost and run time. Here, the shelf life of the lysis and neutralization buffers, the effect of temperature and incubation period during the lysis step, the necessity for drying the slides between the electrophoresis and staining step, and the need to perform the sample workup and electrophoresis steps under subdued light were all evaluated.

Efecto de la hiperglucemia en el síndrome coronario agudo y sus implicaciones en el tratamiento antiagregante plaquetario / Effect of hyperglycemia on acute coronary syndrome and the implications of antiplatelet therapy

RESUMEN La enfermedad cardiovascular representa, según los datos de la Organización Mundial de la Salud, la principal causa de muerte asociada con factores de riesgo como el tabaquismo, el sedentarismo, la hipertensión, la dislipidemia y la diabetes mellitus. Precisamente, esta última enfermedad es una de las que más se relaciona con la aparición, la progresión y las complicaciones de un evento coronario. La hiperglucemia potencia diferentes vías bioquímicas y celulares como la del sorbitol, el factor nuclear kβ, la formación de productos finales de glicación avanzada, la vía de la proteína cinasa C y el estrés oxidativo, que terminan favoreciendo en el paciente coronario un estado proinflamatorio y procoagulante, que se asocia con un peor pronóstico y agrava la lesión miocárdica; además, inhibe y compite con la acción de los antiagregantes plaquetarios, generando resistencia no solo a estos sino también a la terapia trombolítica. Por lo anterior, se hace necesario generar una actualización del tema, para sensibilizar a la comunidad médica sobre la importancia del control glucémico, sobre todo en pacientes con cardiopatía isquémica, y así mejorar las estrategias de control. Se realizó la búsqueda bibliográfica en PubMed, de una forma estructurada, no sistemática. Se incluyeron artículos publicados en inglés y español, sin restricción por fecha de publicación.

SUMMARY According to data from the World Health Organization, cardiovascular disease is the main cause of death associated with risk factors such as smoking, sedentary lifestyle, hypertension, dyslipidemia and diabetes mellitus. Precisely, this last disease is one of the most related to the appearance, progression, and complications of a coronary event. Hyperglycemia potentiates different biochemical and cellular pathways such as sorbitol, the nuclear factor kβ, the formation of advanced glycation end products, the protein kinase C pathway and oxidative stress, which end up favoring in the coronary patient a proinflammatory state and procoagulant, which is associated with a worse prognosis and aggravates myocardial injury; in addition, it inhibits and competes with the action of platelet antiaggregants, generating resistance not only to these but also to thrombolytic therapy. Therefore, it is necessary to generate an update of the topic, to sensitize the medical community about the importance of glycemic control, especially in patients with ischemic heart disease and thus improve control strategies. The bibliographic search was carried out in PubMed, in a structured, non-systematic way. Articles published in English and Spanish were included, without restriction by publication date.

Conocimiento y actitudes de médicos residentes en medicina interna y cirugía general con respecto a la nutrición clínica en 5 universidades del suroccidente colombiano y eje cafetero / Knowledge and Attitudes of resident physicians in internal medicine and general surgery with respect to clinical nutrition in 5 universities of colombian south western and coffee region

INTRODUCCIÓN: Un buen estado nutricional de los pacientes es de vital importancia para su evolución y pronóstico y los conocimientos y actitudes de los médicos son fundamentales en este proceso. OBJETIVO GENERAL: Caracterizar los conocimientos y actitudes de médicos residentes en Medicina Interna y Cirugía General con relación a la nutrición clínica en 5 Universidades del sur occidente y el eje cafetero colombianos y establecer si sus programas académicos influyen en los resultados. METODOLOGIA: Estudio observacional descriptivo de corte transversal con la aplicación de una encuesta de tres módulos: datos sociodemográficos, prueba de conocimientos nutricionales y prueba sobre actitudes en escala Likert. RESULTADOS: Se obtuvo una muestra por conveniencia de 70 participantes siendo la mayoría del género masculino, residentes de medicina interna de primer y segundo año. La media de respuestas acertadas fue de 8/20(IC 95%). El género femenino, los residentes de 1 y 2 año y participantes con menos de 1 año de experiencia clínica obtuvieron mejor promedio de respuestas acertadas. En términos cualitativos 50 participantes obtuvieron calificación "baja" y 20 calificación "regular". Las variables objeto de estudio no mostraron asociación estadísticamente significativa en el resultado final de la prueba de conocimientos. Las respuestas a las preguntas sobre actitudes mostraron una disposición positiva en el 55% de los casos con un grado de indiferencia que oscila alrededor del 20%. DISCUSIÓN Y CONCLUSIONES: Los conocimientos en nutrición clínica de residentes de medicina interna y cirugía general de las universidades del suroccidente colombiano y Eje cafetero son muy escasos. La actitud positiva frente a los temas nutricionales no concuerdan con los bajos resultados en las prueba de conocimientos. Los programas académicos no influyeron en los resultados obtenidos. Deben corregirse estas deficiencias en aras de mejorar la calidad de la atención de los pacientes hospitalizados

INTRODUCTION: The nutritional status of patients plays a fundamental role in the evolution and prognosis of different conditions, and the knowledge and attitudes of physicians are a fundamental part of this process. General objective: To characterize the knowledge and attitudes of resident physicians in internal medicine and general surgery in relation to clinical nutrition in 5 Universities of the southwest and the Colombian coffee axis and establish if their academic programs influence the results obtained. METHODOLOGY: Cross-sectional descriptive observational study with the application of a survey that contains three modules: socio-demographic data, knowledge test on nutritional assessment and artificial nutrition and test of attitudes on Likert scales. RESULTS: A convenience sample of 70 was obtained being the majority of the male gender, residents of internal medicine and first and second year. The average of correct answers was 8/20 (95% CI) the female gender, the residents of 1 and 2 years of residence and the participants with less than 1 year of clinical experience obtained the best average of correct answers. In qualitative terms 50 obtained "low" qualification and 20 "regular" qualification. The variables studied did not show a statistically significant association in the final result of the knowledge test. The answers to the questions on attitudes showed a positive disposition in 55% of the cases with a degree of indifference that oscillates around 20%. DISCUSSION AND CONCLUSIONS: The knowledge in clinical nutrition of residents of internal medicine and general surgery of the universities of southwestern Colombia and the coffee region are very scarce. The positive attitude towards nutritional issues does not agree with the low results in the knowledge test. The academic programs did not influence the results obtained. These deficiencies should be corrected in order to improve the quality of care for hospitalized patients

Estado nutricional y características sociodemográficas de los adultos mayores en 5 hogares geriátricos de dos Municipios del Valle del Cauca, Colombia en el año 2017 / Nutritional status and sociodemographic characteristics of older adults in 5 nursing homes in two Municipality of Valle del Cauca, Colombia in 2017

INTRODUCCIÓN: La desnutrición es definida como un estado patológico y los adultos mayores son vulnerables para sufrirla por lo cual es necesario caracterizar el estado nutricional en esta población. OBJETIVO GENERAL: Determinar el estado nutricional y caracterizar socio demográficamente de adultos mayores en 5 hogares geriátricos en dos municipios del Valle Del cauca, Colombia en el año 2017. METODOLOGIA: Estudio observacional descriptivo de corte transversal aplicando un módulos que recoge información sociodemográfica y un segundo módulo con el cuestionario Mini Nutritional Assessment (MNA). RESULTADOS: Se obtuvo una muestra de 153 participantes, 76 hombres y 77 mujeres, la mayoría con edades entre los 70 y 89 años, 79 de ellos con riesgo de desnutrición, 35 con desnutrición y 39 participantes con estado nutricional normal, 81% de la población estudiada no manifestó pérdida de peso en los últimos 6 meses y un 12% de ellos manifestó perdida de 1 a 2 kg. DISCUSIÓN Y CONCLUSIONES: La población adulta mayor tiene un riesgo elevado de estar en riesgo de desnutrición o de sufrirla como lo demuestra el estudio. No se asocia la percepción de perdida de peso con los datos encontrados con la aplicación del MNA. El manejo nutricional de los adultos mayores debe ser individualizado y acorde a sus patologías y necesidades

INTRODUCTION: Malnutrition is defined as a pathological state and older adults are vulnerable to suffer it, so it is necessary to characterize the nutritional status in this population. GENERAL OBJECTIVE: To determine the nutritional status and demographically characterize senior citizens in 5 nursing homes in two municipalities of Valle Del cauca, Colombia in 2017. METHODOLOGY: Descriptive cross-sectional observational study applying a module that collects sociodemographic information and a second module with the Mini Nutritional Assessment (MNA) questionnaire. RESULTS: A sample of 153 participants was obtained, 76 men and 77 women, the majority with ages between 70 and 89 years, 79 of them with risk of malnutrition, 35 with malnutrition and 39 participants with normal nutritional status, 81% of the The population studied showed no weight loss in the last 6 months and 12% of them showed a loss of 1 to 2 kg. DISCUSSION AND CONCLUSIONS: The elderly population has a high risk of being at risk of malnutrition or suffering from it as the study shows. The perception of weight loss is not asociated with the data found with the application of MNA. The nutritional management of older adults should be individualized and according to their pathologies and needs

Identification, Characterization, Immunolocalization, and Biological Activity of Lucilin Peptide.

Maggots from the Lucilia sp. genus are used for debridement of infected and necrotic wounds. Broad-spectrum antimicrobial activity has been described in the excretion/secretions (ES1) of these larvae. This study identifies the genetic sequence of a cecropin-like antimicrobial peptide from Lucilia eximia. Total RNA was extracted and used for PCR-RACE amplification of a cecropin, the native peptide was immunolocalized in the tissues and secretions of the larvae, and a synthetic analog was used to explore its antimicrobial, cytotoxic, LPS neutralizing and wound-healing activities in vitro. The genetic cDNA sequence of a cecropin-like antimicrobial peptide in L. eximia called "Lucilin" was amplified, corresponding to 63 aa completed protein and 40 aa mature peptide; the structure of the mature peptide was predicted as an α-helix. The peptide was immunolocalized in the salivary glands, fat body, the ES, and hemolymph of the maggots. Lucilin synthetic peptide analog was active against E. coli DH10B with a MIC2 of 7.8 µg/mL, E. coli extended spectrum b-lactamase (ESBL) (MIC: 15.6 µg/mL), and Enterobacter cloacae (MIC: 125 µg/mL), but it was not active against Pseudomonas aeruginosa and Staphylococcus epidermidis; and had no cytotoxic or hemolytic activity. It showed immunomodulatory activity against human peripheral blood mononuclear cells (PBMCs) stimulated with LPS, reducing the TNF-α production when treated at 17 µg/mL and induces cell migration of Hacat at 5 and 50 µg/mL. Lucilin is a cecropin-like peptide from L. eximia with antimicrobial activity against Gram negative bacteria and immunomodulatory activities, decreasing the TNF-α production in PBMCs and inducing cellular migration in human keratinocytes.

25-Hydroxyvitamin D levels of children are inversely related to adiposity assessed by body mass index

Vitamin D deficiency is associated with wide range of pathologies. Some evidences have shown that low vitamin D circulating levels in children and adolescent are related to fat mass and obesity. The objectives of the present study were to characterize vitamin D status in children and adolescents and to determine if serum 25-hydroxyvitamin D (25(OH)D) concentration is related to adiposity assessed by body mass index (BMI). Serum 25(OH)D levels were measured by LIAISON method in 471 children and adolescents (2 to 18 years age) and analyzed according to gender, pubertal period, age, and BMI. An overall prevalence of 25(OH)D insufficiency and deficiency was present in the 67.1%. Lower 25(OH)D levels were found in females (25.56 ± 14.03 vs 29.71 ± 17.10 ng ml−1; P = 0.004) and pubertal children (25.52 ± 13.97 vs 29.21 ± 16.83 ng ml−1; P = 0.011). In addition, an inverse relation of BMI and age on 25(OH)D concentrations was observed in children. In conclusion, low vitamin D status was highly prevalent among children and adolescents. Of note, a non-lineal regression model showed that 39.6% of vitamin D levels variability was explained by BMI. These results indicate that adiposity assessed by BMI impacts vitamin D status

25-Hydroxyvitamin D levels of children are inversely related to adiposity assessed by body mass index.

Vitamin D deficiency is associated with wide range of pathologies. Some evidences have shown that low vitamin D circulating levels in children and adolescent are related to fat mass and obesity. The objectives of the present study were to characterize vitamin D status in children and adolescents and to determine if serum 25-hydroxyvitamin D (25(OH)D) concentration is related to adiposity assessed by body mass index (BMI). Serum 25(OH)D levels were measured by LIAISON method in 471 children and adolescents (2 to 18 years age) and analyzed according to gender, pubertal period, age, and BMI. An overall prevalence of 25(OH)D insufficiency and deficiency was present in the 67.1%. Lower 25(OH)D levels were found in females (25.56 ± 14.03 vs 29.71 ± 17.10 ng ml-1; P = 0.004) and pubertal children (25.52 ± 13.97 vs 29.21 ± 16.83 ng ml-1; P = 0.011). In addition, an inverse relation of BMI and age on 25(OH)D concentrations was observed in children. In conclusion, low vitamin D status was highly prevalent among children and adolescents. Of note, a non-lineal regression model showed that 39.6% of vitamin D levels variability was explained by BMI. These results indicate that adiposity assessed by BMI impacts vitamin D status.

Identification and characterization of novel cecropins from the Oxysternon conspicillatum neotropic dung beetle.

Dung beetles are exposed to a complex microbiological ecosystem during their life cycle. Characterization of novel host-defense peptides (HDP) is essential to understanding the host innate immune response in insects. It constitutes a promising alternative to look for new therapeutic agents against pathogenic microbes. We identified four new HDP, Oxysterlins 1, 2, 3, and 4 from the transcriptome of the Oxysternon conspicillatum dung beetle. These HDP display a highly conserved signal peptide and a mature peptide, characterized by an overall positive charge (cationic) (pI: 10.23-11.49), a hydrophobic ratio (ΦH: 35-41), and amphipathicity. Oxysterlins 1, 2, and 3 have a linear α-helix structure, whilst Oxysterlin 4 has a mixture of both α-helix and ß-sheet structures without disulfide bonds through bioinformatics prediction and circular dichroism. Oxysterlins are part of the cecropin family group in an exclusive clade related to beetle cecropins. They have predominant antimicrobial activity against Gram-negative bacteria, including multidrug resistant strains (3.12-50 µg/mL) measured by plate microdilution. Their kinetics, in a time-killing curve showed concentration-dependent bactericidal activity. Furthermore, these HDP have low toxicity against human erythrocytes (62.5-500 µg/mL) and Vero cells (250-500 µg/mL). This article describes new HDP of the cecropin family from the Oxysternon conspicillatum dung beetle, with antimicrobial activity against multidrug resistant bacteria and low toxicity.